Question
What is the name of your state? North carolina....generally speaking...I am trying to find out about pre-existing conditions and health insurance...my baby was born with disabilities/birth defects which will affect him for the rest of his life, we are on a group health insurance plan with my spouse's employer...if he changes jobs, will our son be excluded from coverage? I am THINKING that he would be accepted b/c hes been on a group plan if he takes a job with another GROUP plan....but is there a time limit we are looking at here? what if he loses his job and 8 months later finds another one?? what if its 2 years before he finds another one?? what about if he gets a job in another state??
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As long as you remain covered under (most) group plans, the pre-ex should not be an issue. If employment is terminated you need to continue COBRA for your child at the very least.
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For the future, does anyone know if there ARE insurance plans that don't have pre-existing condition exclusions? I worry about him being uninsurable as an adult...our system seems to be set up to make you NOT want to work so you could qualify for medicaid in a situation like this...
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my son doesnt qualify for medicaid because my husband makes too much money......so basically we can make all this money and go into terrible debt b/c thats how the system is set up....if he made average money, we wouldnt have to pay for ANY medical bills....
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I'm sorry, I thought you were looking for answers to your questions . . .
In addition to group coverage & COBRA your carrier will also offer a conversion plan. Some states have high risk pools and yours might be one of them.
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There is a specific Federal law, HIPAA, which was put into place specifically to help you in this kind of situation. HIPAA applies when you are going from one GROUP policy to another GROUP policy and is specifically designed to allow people to change jobs without losing health care coverage for pre-existing conditions.
When you leave one job and your group insurance is cancelled, you have up to 62 days to become covered on another group plan. As long as you become covered on a group plan within that period of time, the law prohibits your new group policy from calling any condition pre-existing.
If the likelihood is that you will not be able to pick up another group plan until after 62 days have expired, there is another Federal law, COBRA, which will help. If the first employer had more than 20 employees, they are REQUIRED to allow you to continue to remain on the first employer's insurance, at your own expense, for up to 18 months or until you become eligible for a new employer's group plan. This should prevent the 62 day gap from becoming a factor.
All of the above assumes that you were covered on the first group plan for 12 months or more. If you were covered on the first plan for less than 12 months, the plan can consider a condition pre-existing for the difference between the length of time you WERE covered, and 12 months. For example, if you were covered on the first group plan for eight months, the second group plan can consider the condition pre-existing for four months.
Even if something were to happens so that your coverage was no longer creditable (you were on COBRA the entire 18 months and still did not pick up a new group plan until more than 62 days after COBRA expired, for example) the LONGEST that your new plan could consider your son's condition pre-existing is one year (eighteen months in very, very, limited circumstances which are unlikely to occur). As long as you stay on group coverage, there will NEVER be a situation in which your son's condition is considered pre-ex permanently and will never be covered.
Yes, there are insurance plans that do not have any pre-ex clauses, but as long as you are careful to keep your group insurance in place (through COBRA, if necessary) that shouldn't ever be a factor.
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